Efficient delivery of health care services depends on people's ability to accurately assess the severity of their pain and seek medical care promptly when it is needed. Yet empirical studies have identified many instances in which people systematically misvalue their pain-e.g., patients experiencing heart failure may delay seeking medical attention for several hours after the onset of severe physical symptoms, often with lethal consequences. The goal ofthe proposed research is to investigate the psychological and neural mechanisms underlying the valuation of pain and explain why and how failures of valuation occur. Behavioral and functional neuroimaging experiments will investigate (a) the relation between different types of valuation of pain (e.g., experienced versus remembered pain, (b) the relation between individual differences in pain valuation and dispositional differences in negative affect, and (c) the neural pathways that mediate the influence of different types of pain valuation on decision-making. By advancing our understanding ofthe psychological and neural mechanisms involved in pain-related decision-making, the proposed experiments can potentially help to improve measurement of pain in clinical settings and develop novel interventions to enhance the quality of patients' pain-related decisions. Public health relevance: This research seeks to understand how people determine the value of their pain when making pain-related decisions. The proposed experiments have the potential to explain why it is that people often make poor decisions about pain, e.g., failing to seek prompt medical attention when experiencing severe physical symptoms. By shedding light on the mechanisms involved in pain-related decision-making, the research has the potential to improve measurement of pain in clinical settings and to develop more effective policies for identifying and treating individuals at risk for misreporting of physical symptoms. PHS 416-1 (Rev, 9/08) Page 2 Number pages consecutively at the bottom throughout Form Page 2 the application. Do not use suffixes such as 2a, 2b, Kirschstein-NRSA Individual Fellowship Application NAME OF APPLICANT (Lasf, first middle initial) Yarkoni, Tai (To be completed by applicant- follow PHS 416-1 instructions) 18. GOALS FOR KIRSCHSTEIN-NRSA FELLOWSHIP TRAINING AND CAREER My long-term goal is to develop an interdisciplinary research program in the area of cognition-emotion interaction and decision-making by setting up a cognitive neuroscience laboratory at a first-tier research university. To achieve this goal, I have developed my NRSA fellowship application with three aims in mind. First, I will extend my present basic research on economic decision-making to the domain of physical pain. Physical pain is a biologically-salient, experimentally-controllable signal of considerable clinical importance, and thus presents ideal domain for translational research on emotional and cognitive influences on decision- making. My intellectual development in this area will benefit greatly from Dr. Tor Wager's expertise in the cognitive neuroscience of pain. Second, I aim to acquire expertise in the use of a state-of-the-art multilevel modeling approach to fMRI analysis currently being developed in Dr. Wager's lab. This approach affords powerful investigation of questions that cannot be easily addressed using the analyses techniques I am currently familiar with. Third, I aim to develop a truly interdisciplinary perspective on human decision-making by supplementing my background in cognitive neuroscience with a better understanding of behavioral economic models and techniques. My development in this area will be supported by Dr. Elke Weber, a leading expert in the area of judgment and decision-making. 19. ACTIVITIES PLANNED UNDER THIS AWARD: Approximate percentage of proposed award time In activities identified below. (See instructions.) Year Research Course Work Teaching Clinical First 90 10 Sec 100 Thir 100 PREDOCTORAL FELLOWSHIPS ONLY Four th Fifth MD/PhD FELLOWSHIPS ONLY Sixt h Briefly explain activities other than research and relate them to the proposed research training. In my first year, I will enroll in or audit classes on multivariate statistics, pain, and behavioral economics intended to provide me with the skills needed to carry out the proposed experiments. 20, TRAINING SITE(S) Is the Primary Training Site the same as the Sponsoring Institution? Yes D No If No, provide detailed information below for the Primary Training Site Location Organizational Name: DUNS: Streeti: street 2: City: County: state: Province: Country: Zip/Postal Code: